Aims and scope
Announcements
Editorial board by country/region
73 editors and editorial board members in 19 countries/regions 1 United States of America (29)
2 Australia (14) 3 United Kingdom (6)
See more editors by country/region
Editorial board
Editorial board
Menu Search in this journal
Research in Social and Administrative Pharmacy
Supports open access
5.1
CiteScore
3.348
Impact Factor
Submit your article Guide for authors
Shane Desselle, RPh, PhD, FAPhA
Mohamed E. K. Amin, PhD
Parisa Aslani, PhD, MSc, BPharm(Hons), Grad Cert Ed Stud (Higher Ed)
Victoria Garcia Cardenas, PhD
Aleda M. H. Chen, PhD
Dalia Dawoud, PhD, MSc, BSc, GCAP
Anandi Law, B.Pharm, PhD
Carlo Marra Editor-in-Chief
Associate Editors
Touro University California, Vallejo, California, United States of America
Beirut Arab University, Beirut, Lebanon
The University of Sydney, Sydney, NSW, Australia
University of Technology Sydney, Broadway, Australia
Cedarville University, Cedarville, Ohio, United States of America
National Institute for Health and Care Excellence, London, United Kingdom
Western University of Health Sciences, Pomona, California, United States of America
Lotte Stig Norgaard, PhD
Carl R Schneider, PhD, BPharm(Hon), BN
Marcia Worley, PhD, RPh, FAPhA
Katri Aaltonen
Ephrem Abebe, PhD
Nagham Ailabouni, PhD
Asnakew Ayele, PhD
Hirsham Badreldin, PhD Editorial Board
University of Otago, Dunedin, New Zealand
University of Copenhagen, Copenhagen, Denmark
The University of Sydney Faculty of Medicine and Health, Sydney, Australia
The Ohio State University Division of Outcomes and Translational Sciences, Columbus, Ohio, United States of America
Helsinki, Finland
Purdue University College of Pharmacy, West Lafayette, Indiana, United States of America
University of South Australia, Adelaide, Australia
University of Gondar College of Medicine and Health Sciences, Gondar, Ethiopia
King Saud University, Riyadh, Saudi Arabia
Matthew J. Boyd, BPharm (Hons), PhD
Todd A. Boyd, PhD, PhD
Cathal Cadogan, PhD
Stephen Carter, BPharm MSc PhD
Jongwha Chang, MSPH, PhD
Antoinette Coe, PhD
Jack Collins, PhD
Geoffrey Curran, PhD
Sarah Dineen-Griffin, PhD
Daniel Erku, BPharm, PhD
University of Nottingham, Nottingham, United Kingdom
Saint Francis Xavier University, Antigonish, Nova Scotia, Canada
Royal College of Surgeons in Ireland, Dublin, Ireland
The University of Sydney, Sydney, New South Wales, Australia
The University of Texas at El Paso School of Pharmacy, El Paso, Texas, United States of America
University of Michigan, Ann Arbor, Michigan, United States of America
The University of Sydney, Sydney, New South Wales, Australia
University of Arkansas for Medical Sciences, Little Rock, Arkansas, United States of America
Charles Sturt University - Bathurst Campus, Bathurst, Australia
Erwin Martinez Faller, MSPharm, RPh,MMPS,PhD (Pharmacy), PhD (Pharm Educ), FRIPharm
Mark Fleming, PhD
Jay Ford, PhD, FACHE, LFHIMSS
João Gregório, PharmD, MSc, PhD
Monica Holiday-Goodman, PhD
Sherilyn K. D. Houle, PhD
Karen S. Hudmon, DsPH, MS, BSPharm
Rabia Hussain, PharmD, MPhil, PhD
Griffith University, School of Medicine and Menzies Health Institute Queensland, Centre for Applied Health Economics, Queensland, Australia
Management and Science University, Jalan Persiaran Olahraga, Selangor Darul Ehsan, Malaysia
Chapman University, Orange, California, United States of America
University of Wisconsin-Madison, Madison, Wisconsin, United States of America
Lusophone University of Humanities and Technologies Research Centre for Biosciences and Health Technologies, Lisboa, Portugal
The University of Toledo, Toledo, Ohio, United States of America
University of Waterloo, Waterloo, Ontario, Canada
Purdue University, West Lafayette, Indiana, United States of America
University of Sains Malaysia, Penang, Malaysia
Laney Jones, PharmD, MPH
Lisa Kalisch Ellett, BPharm, PhD
Mary Jo Knobloch, MPH, CPH
Cherie Lucas, PhD, BPharm, GradCertEduStud (Higher Ed), MPS
Beth A. Martin, PhD
Lisa McCarthy, PhD
Sara McMillan, PhD, Grad Cert Higher Ed, BPharm
Kevin Mc Namara, PhD
Brittany Melton, PharmD, PhD
Daniela Moga, PhD
Geisinger Health, Danville, Pennsylvania, United States of America
University of South Australia, Adelaide, Australia
University of Wisconsin-Madison, Madison, Wisconsin, United States of America
University of Technology Sydney, Broadway, Australia
University of Wisconsin System, Madison, Wisconsin, United States of America
University of Toronto, Toronto, Ontario, Canada
Griffith University, Nathan, Queensland, Australia
Deakin University, Geelong, Australia
University of Kansas School of Pharmacy, Lawrence, Kansas, United States of America
Frank Moriarty, MPharm, PhD
Kevin Murphy, PhD
Marwa Noureldin, PharmD, MS, PhD, BCGP
Myuiwa Omonaiye, PhD
Isha Patel, PhD
Jason Perepelkin, PhD
Adam Rathbone, PhD MPharm, PGClinDip MRPharmS, SFHEA
Anna Robinson, MPharm, PG Dip (Adv.)
Maguy Saffouh El Hajj, BScPharm, Pharm D, BCPS
University of Kentucky, Lexington, Kentucky, United States of America
Royal College of Surgeons in Ireland, Dublin, Ireland
University College Cork, Cork, Ireland
Manchester University College of Pharmacy Natural & Health Sciences, Fort Wayne, Indiana, United States of America
Deakin University, Geelong, Australia
Marshall University, Huntington, West Virginia, United States of America
University of Saskatchewan, Saskatoon, Saskatchewan, Canada
Newcastle University, Newcastle Upon Tyne, United Kingdom
Newcastle University, Newcastle Upon Tyne, United Kingdom
Teresa Salgado, PhD
Jayashri Sankaranarayanan, MPharm, PhD
Kritsanee Saramunee, BSc in Pharm, MSc, PhD
Theresa J. Schindel, BSP, MCE, PhD, FCSHP
James Schreiber, PhD
Mary C. Schroeder, PhD
Bupendra Shah, PhD
Natalia Shcherbakova, PhD
Olayinka Shiyanbola, BPharm, PhD
Qatar University, Doha, Qatar
Virginia Commonwealth University, Richmond, Virginia, United States of America
University of Nebraska Medical Center, Omaha, Nebraska, United States of America
Mahasarakham University, Faculty of Pharmacy, Maha Sarakham, Thailand
, Canada
Duquesne University, Pittsburgh, Pennsylvania, United States of America
The University of Iowa, Iowa City, Iowa, United States of America
Long Island University - Brooklyn Campus, New York, New York, United States of America
Western New England University, Springfield, Massachusetts, United States of America
University of Wisconsin-Madison School of Pharmacy, Madison, Wisconsin, United States of America
Reshmi Singh, PhD, MS. BPharm.
Andrew Sturrock, PhD
Ricky Suchak, MS, MBA
Carolina Ung, PhD
Elizabeth Unni, PhD, MBA, BPharm
Daisy Volmer, M.Sc. (Pharm)
Anita Weidmann, PhD
Natalie Weir, MPharm, PhD
Kyle Wilby, BSP, PharmD, PhD
University of Wyoming, Laramie, Wyoming, United States of America
University of Sunderland, Sunderland, United Kingdom
Sandoz AG, Basel, Switzerland
University of Macau, Taipa, Macao
Roseman University of Health Sciences South Jordan Campus, South Jordan, Utah, United States of America
University of Tartu, Tartu, Estonia
University of Innsbruck, Innsbruck, Austria
University of Strathclyde, Glasgow, United Kingdom
University of Otago, Dunedin, New Zealand
Matthew J. Witry, PhD
Phillip Woods, PhD
Copyright © 2022 Elsevier B.V. or its licensors or contributors.
ScienceDirect® is a registered trademark of Elsevier B.V.
The University of Iowa, Iowa City, Iowa, United States of America
Griffith University, Nathan, Queensland, Australia
All members of the Editorial Board have identified their affiliated institutions or organizations, along with the corresponding country or geographic region. Elsevier remains neutral with regard to any
jurisdictional claims.
TABLE OF CONTENTS
November 2022 Issue 18 • Number 11
EDITORIAL
Health literacy: A field for pharmaceutical intervention
F.J. Ferreira Alfaya, M.J. Zarzuelo Romero 3867
REVIEW ARTICLES
Facilitating healthcare practitioners to deliver self-management support in adult cancer survivors: A realist review K. Kantilal, W. Hardeman, H. Whiteside, E. Karapanagiotou, M. Small, D. Bhattacharya
3870
A systematic review on pharmacists’ turnover and turnover intention
S.M. Thin, B. Chongmelaxme, S. Watcharadamrongkun, T. Kanjanarach, B.A. Sorofman, T. Kittisopee
3884
Mental health training programs for community pharmacists, pharmacy staff and students: A systematic review C. Crespo‑Gonzalez, S. Dineen‑Griffin, J. Rae, R.A. Hill
3895
ORIGINAL RESEARCH
Acceptance and willingness to pay under the different COVID-19 vaccines: A contingent valuation method
V. Prasert, M. Thavorncharoensap, P. Vatcharavongvan 3911
Oral anticoagulant adherence and switching in patients with atrial fibrillation: A prospective observational study
S. Salmasi, A. Safari, A. Kapanen, A. Adelakun, L. Kwan, J. MacGillivray, J.G. Andrade, M.W. Deyell, P. Loewen 3920 Consumers’ self-reported adherence to directions for non-prescription medicines and the role of risk perception
S.K. Vong, L. Kang, S.R. Carter
3929
Drug-related problems and satisfaction among patients receiving pharmacist-led consultations at the initiation of cardiovascular drugs
S. Bremer, S. Henjum, E.M. Sæther, R. Hovland
3939
Exploring community pharmacists’ use of health literacy interventions in their everyday practice T. Cork, S. White
3948
Effectiveness and sustainment of a tailored over-the-counter medication safety intervention in community pharmacies: A randomized controlled trial
M.A. Chui, M.E. Berbakov, A.M. Gilson, A.O. Morris, J.A. Stone
3953
Pharmacists’ continuing professional development for non-communicable diseases management: A consensus study
B. Marjadi, R. Alfian, Y. Susanto, L. Tjandra, A.N.W. Pratama, C. Schneider
3964
Review of position statements on antimicrobial resistance and stewardship from professional pharmacy organisations
K. Lim, A. Olsen, A. Broom, H. Seale
3974
Cost-effectiveness of central automated unit dose dispensing with barcode-assisted medication administration in a hospital setting
J.G. Jessurun, N.G.M. Hunfeld, M. van Dijk, P.M.L.A. van den Bemt, S. Polinder
3980
Work productivity loss among adults aged 18–64 years with Multiple Sclerosis in the United States:
A propensity score matched study
S. Bhattacharjee, Z. Yegezu, K. Kollecas, K. Duhrkopf, N. Greene, L. Hashemi
3988
COMMENTARY
State-level policy efforts to regulate pharmacy benefit managers (PBMs) T.J. Mattingly II, M. Lewis, M.P. Socal, G. Bai
3995
RESEARCH BRIEF
The development of a taxonomy to support goal setting between mental health consumers and community pharmacists
V. Stewart, S.S. McMillan, A.J. Wheeler
4003
CASE REPORT
Severity of visual hallucinations worsened with lisinopril despite receiving sedative hypnotic therapy or antipsychotic therapy: First case report
M.A. Jalloh, K. Chung, S. Doroudgar
4009
LETTER TO THE EDITOR
Pharmacist interventions to deprescribe benzodiazepines in older adults: A missed opportunity?
C.A. Cadogan
4012
CORRIGENDUM
Corrigendum to “Using the behavior change wheel to link published deprescribing strategies to identified local primary healthcare needs” [Res. Soc. Adm. Pharm. (2022) 3350–3357]
I. Bai, J.E. Isenor, E. Reeve, A.M. Whelan, R. Martin‑Misener, S. Burgess, N. Kennie‑Kaulbach
4016
Research in Social and Administrative Pharmacy xxx (xxxx) xxx
Available online 9 July 2022
1551-7411/© 2022 Elsevier Inc. All rights reserved.
Pharmacists ’ continuing professional development for non-communicable diseases management: A consensus study
Brahmaputra Marjadi
a,c,*, Riza Alfian
b, Yugo Susanto
b, Lusiani Tjandra
c, Antonius Nugraha Widhi Pratama
d, Carl Schneider
eaSchool of Medicine, Western Sydney University, Locked Bag 1797, Penrith, NSW, 2751, Australia
bSekolah Tinggi Ilmu Kesehatan ISFI Banjarmasin, Jl. Flamboyan III No.7C, Banjarmasin, Kalimantan Selatan, 70123, Indonesia
cFaculty of Medicine, Universitas Wijaya Kusuma Surabaya, Jalan Dukuh Kupang XXV/54, Surabaya, 60225, Indonesia
dFaculty of Pharmacy, Universitas Jember, Jalan Kalimantan I No. 2, Sumbersari, Jember, 68121, Indonesia
eSchool of Pharmacy, Faculty of Medicine and Health, The University of Sydney, N517, Pharmacy and Bank Building A15, NSW, 2006, Australia
A R T I C L E I N F O Keywords:
Pharmacist
Continuing professional development Needs assessment
Co-design
Nominal group technique Indonesia
A B S T R A C T
Background: Pharmaceutical care for non-communicable diseases (NCD) in Indonesia needs improvement espe- cially in provinces like Kalimantan Selatan (Kalsel) with increasing NCD prevalence. This research explored possible improvements for Kalsel pharmacists NCD Continuing Professional Development (CPD) programmes.
Objectives: The study aims to identify Kalsel pharmacists’ engagement with, experiences of, and expectations for NCD-focused CPD activities, and CPD stakeholders’ views on these expectations.
Methods: This sequential mixed-methods study used a quantitative survey to map Kalsel pharmacists’ CPD engagement and preferences. The survey findings, and Kalsel pharmacists’ knowledge and skills in NCD man- agement, were further explored in four geographically-diverse focus group discussions (FGDs). Triangulated findings from the survey and FGDs were presented to pharmacist CPD stakeholders in a modified Nominal Group Technique (NGT) discussion, resulting in a prioritised list of CPD activities and allocation of local leadership for each activity.
Results: The survey response rate was 51% (249/490) with fair representation of the geographic spread. CPD sessions were seen as a social event to network with colleagues (34%) and improve knowledge (31%). Major hindrances for participation were work commitments (25%) and travel needs (22%). Most participants (64%), especially the more senior, preferred explicitly interactive CPD formats (adjusted odds ratio 0.94 for each additional year from graduation; 95% confidence interval 0.89–0.99; p =0.036). The FGDs identified challenges in managing NCD, strengths and gaps in NCD knowledge, and preferences for NCD CPD. The modified NGT produced 12 actions which five major stakeholders agreed to lead.
Conclusions: An explicitly interactive NCD CPD programme based on a community of practice model and sup- ported by blended learning is likely to be most effective for pharmacists in the Kalimantan Selatan province of Indonesia. A co-designed multi-stakeholder systems-based approach to CPD programme, as used in this study, is likely to increase the engagement and success of the programme.
1. Background
Non-communicable diseases (NCD) – cardiovascular diseases, can- cers, diabetes mellitus, chronic lung diseases1 – are a growing concern in Indonesia. The increase of NCD prevalence has led to overruns in health costs.2 Cardiovascular diseases are the main cause of NCD morbidity and mortality in Indonesia alongside diabetes mellitus.2–4
The Kalimantan Selatan (Kalsel) province of Indonesia has been re- ported as having alarming NCD prevalences which have increased be- tween the 5-yearly National Basic Health Research 20133 and 2018.4 Across the 34 provinces nationwide, in 2018 Kalsel ranked 1st in hy- pertension prevalence (from 2nd in 2013), 5th for stroke (6th in 2013) and 14th for diabetes (17th in 2015). Between 2013 and 2018, there was an increase in the prevalence of medically diagnosed hypertension from
* Corresponding author. School of Medicine, Western Sydney University, Locked Bag 1797, Penrith, NSW, 2751, Australia.
E-mail addresses: [email protected] (B. Marjadi), [email protected] (R. Alfian), [email protected] (Y. Susanto), lusianiws@uwks.
ac.id (L. Tjandra), [email protected] (A.N.W. Pratama), [email protected] (C. Schneider).
Contents lists available at ScienceDirect
Research in Social and Administrative Pharmacy
journal homepage: www.elsevier.com/locate/rsap
https://doi.org/10.1016/j.sapharm.2022.07.002
Received 16 March 2022; Received in revised form 6 July 2022; Accepted 7 July 2022
Research in Social and Administrative Pharmacy xxx (xxxx) xxx
2 30.8% to 44.1%, stroke from 9.2‰ to 12.7‰, and diabetes mellitus from 1.4% to 18%.3,4
Indonesia has produced a framework for pharmacists’ contribution to clinical care.5 One example of the application of that framework in NCD management is the role of pharmacists in providing patient edu- cation for lifestyle changes.1 Such education is deliverable by commu- nity pharmacies in Indonesia in line with their increasing role in primary care,6 where pharmacists work with patients and other health pro- fessionals as partners in the delivery of pharmaceutical care.5 There has been evidence for the positive effect of Indonesian pharmacists in NCD management and education.7,8 However, the shortage of clinically trained and suitably-educated pharmacists constitutes a key barrier to a broad implementation of this role.9
All Indonesian pharmacists (Apoteker =Apt.) must complete a four- year Bachelor of Pharmacy programme (Sarjana Farmasi =S. Farm.) followed by a one-year Pharmacist Professional programme.10,11 The Bachelor of Pharmacy programme covers four broad areas of Pharmacy:
Pharmaceutics, Pharmaceutical Biology, Pharmaceutical Chemistry, and Biomedical, Clinical and Social Pharmacy. The Pharmacist Professional Training programme includes Pharmacy Management and Pharmacy Practice in at least two settings: community pharmacy, hospital, phar- maceutical industry, community health centre (Pusat Kesehatan Masyarakat =Puskesmas), government organisation, pharmacy distrib- utor, or other relevant institutions. Indonesia also has vocational degree in pharmacy, but the graduates cannot enrol to a Pharmacist Profes- sional programme.10,11
To complete the Pharmacist Professional programme, a candidate must pass the Indonesian Pharmacist Competency Examination (Ujian Kompetensi Apoteker Indonesia =UKAI) which consists of an Objective Structured Clinical Examination and a Computer-Based Test. Upon passing this examination, they obtain a Pharmacist Certificate of Competence which is required to apply for the Letter of Registration in the national registry database (Surat Tanda Registrasi Apoteker =STRA).
A valid Certificate of Competence and Letter of Registration are required for a pharmacist to practice.5,12–14 Both the Pharmacist Certificate of Competence and the Letter of Registration need to be renewed every five years through re-certification.15 A pharmacist needs to collect 150 credits in the five-year period, with evidence of participation in several domains: professional practice (40–50% of total credits), educa- tion/learning through continuing professional development (CPD;
40–50%), community service (5–15%), scientific publication (0–25%), and pharmaceutical science development (0–25%).14 The re-certification uses an online system called the Pharmacist Information System (Sistem Informasi Apoteker =SIAp). All Indonesian pharmacists must register to this system. They can search available CPD events, register to attend, and receive certificate of participation directly on the system.
The amount of credit earned from a CPD programme is determined by the national or provincial Indonesian Pharmacist Association (Ikatan Apoteker Indonesia =IAI) after the CPD committee register their pro- gramme. The CPD amount of credit depends on one’s role in the CPD (a speaker, moderator, audience, or organiser); CPD scope (from local to international); CPD length; and CPD mode (in-person or online).14 For example, attending a 3-h online seminar with two speakers (https://p2ab.net/#!/cpd/showcase) earns 3 credits; reading and answering questions of an online CPD article (https://kalbemed.
com/cpd) gives 2 credits; and attending IAI national three-day online Annual Scientific Meeting (https://www.iai.id/gallery/kongres-xxi-pit -virtual-iai-2022-2nd-announcement) gives 30 credits.
A large proportion of practicing pharmacists in the Kalsel province graduated prior to the shift of focus in pharmacists’ role from dispensing to a wider range of pharmaceutical care.16–18 The Kalsel chapter of the IAI has identified anecdotal evidence which indicated that Kalsel pharmacists may not be adequately equipped to manage NCD at the primary (community pharmacy and community health centre) and secondary (hospital) care levels. The Kalsel IAI had been running
seminars, mainly in the capital city of Banjarmasin; however, it was unknown whether this CPD model was optimal in meeting pharmacists’
professional development needs. This concern concurred with research evidence which indicates that current CPD in Indonesia is perceived to be deficient in upskilling the pharmacy workforce.5
This paper reports the findings from a mixed methods consensus study which was co-designed by Kalsel IAI members and university- based researchers from Indonesia and Australia. The study aims were to identify: (a) Kalsel pharmacists’ involvement with current CPD ac- tivities; (b) their experiences in managing NCD; (c) their expectations for NCD-focused CPD activities; and (d) Kalsel pharmacist CPD stake- holders’ views on NCD-focused CPD activities. The findings of the study were expected to provide an evidence base for the Kalsel IAI in devel- oping an optimised NCD CPD programme.
2. Methods
A sequential mixed-methods consensus design was employed. An initial quantitative survey of all Kalsel pharmacists on the Kalsel IAI registry was undertaken, followed by a series of focus group discussions (FGD), and concluding with a consensus-building meeting of the main pharmacist CPD stakeholders i.e. the Kalsel IAI, the Kalsel Provincial Health Department, and the Faculty of Pharmacy of Lambung Man- gkurat University. Ethical clearance for this two-country collaboration project was obtained from Universitas Lambung Mangkurat, Kalsel (94/
KEPK-FK UNLAM/EC/III/2019) and from Western Sydney University, Australia (H12803).
A participatory or co-design approach was employed, starting with the composition of the research team and the co-production of knowl- edge with participant stakeholders.19,20 The research team included Kalsel IAI members who had served on the Kalsel IAI Board (RA, YS), pharmacy academics from Indonesia (LT, ANWP) and Australia (CS), and an Indonesian public health academic who had taught in both countries (BM). The Indonesian researchers had completed master’s degrees in Clinical Pharmacy (RA, YS), Medical Science (LT), and Public Health (ANWP). The Australian researchers had doctoral degrees and had supervised postgraduate research projects on the topic of pharmacy services in Indonesia. All researchers had had previous training on the methods used in this project (quantitative survey, FGD, and consensus building).
2.1. Quantitative survey
A quantitative survey was used to map Kalsel pharmacists’ engage- ment with CPD activities and their preferences for future NCD CPD events. The questionnaire was based on the literature and guidelines on NCD and/or CPD in Indonesia and other countries1,21–23 and incorpo- rated empirical insights from the Kalsel IAI leaders. The survey was developed in English by the research team, translated to Indonesian with back-translation by bilingual researchers (BM, RA), and delivered in Indonesian. The survey was distributed via paper and online (Qualtrics) formats to all Kalsel pharmacists on the Kalsel IAI registry. Participation in the survey was voluntary and anonymous. Participants expressed their implied consent by responding to and submitting the survey. Par- ticipants were offered two professional credit points (equal to the pro- fessional credit points for seminar attendance) for their participation through a de-linked provision of details at the end of the survey. Par- ticipants from three pre-determined districts (see FGD methods below) were asked if they were willing to attend a follow-up focus group discussion.
Participant characteristics were analysed descriptively (by BM, RA, YS, AP and CS). Logistic regression with a backward elimination method was conducted to obtain a model that best explained the most preferred CPD format as opted by the participants, categorised as ‘explicitly interactive’ or ‘non-explicitly interactive’. Explicitly interactive CPD formats included seminars (defined as ‘a lecture with audience B. Marjadi et al.
Research in Social and Administrative Pharmacy xxx (xxxx) xxx interaction’), case studies with peers, and learning from peers (men-
toring, discussion and meetings). Non-explicitly interactive formats included postgraduate education, reading journal articles, scientific congress attendance, short courses (1–2 days), classes or lectures, internet materials, webinars, DVD or CD materials, textbooks, literature from drug or health device manufacturers, scientific workshops, peer- reviewing for academic journals and internship. Postgraduate educa- tion sessions and scientific congress presentations are categorised as non-explicitly interactive since in Indonesia they are mainly didactic with minimum amount of participants’ active engagement. In most cases time for question-and-answer is very limited and, especially in congress sessions, only one or two questions could be raised.
Prior to undertaking the logistic regression, included explanatory variables were checked for multicollinearity using Pearson’s product- moment correlation or Spearman’s rho-rank order correlation as appropriate. Those explanatory variables were age, work experience, daily working hours, places of work, total number of workplaces, posi- tion in main pharmacy workplace, use of social media for CPD, opinion on whether CPD should be made compulsory, distance from the capital city, years from graduation, and monthly average CPD activities in the past year. All analyses were conducted by BM, ANWP and CS using STATA release 13 (StataCorp LP, College Station, Texas, US) with 0.05 as the level of statistical significance.
2.2. Focus group discussions
Focus group discussions (FGD) were held in three pre-determined districts based on geographical categories (rural, peri-urban and urban). The district selection was based on nominations from the Kalsel IAI leaders who were consulted throughout the project design. Two FGDs were run at the urban setting due to the high number of phar- macists in the area, which is a common phenomenon in Indonesia.24
The FGDs were comprised of three phases. First, participants were asked about their day-to-day experiences in providing pharmaceutical services for patients with NCD. Second, two NCD case studies were presented to trigger participants’ discussion on their NCD knowledge and skills. One case was a patient who took a mucolytic for an angio- tensin converting enzyme (ACE) inhibitor-induced cough; this case was used in a previous study on self-medication advice by pharmacy staff in a rural Indonesian setting.25 The second case was a patient with uncon- trolled diabetes mellitus and poor kidney function who was prescribed metformin; this case was adapted from a US pharmacist CPD case study.26 Lastly, participants were asked about their views on NCD CPD.
Each FGD was run face-to-face for approximately 90 min in the Indonesian language and was jointly facilitated by Indonesian research team members (BM, YS, RA). A non-Indonesian researcher (CS) partic- ipated via simultaneous bi-directional translation by BM. The four FGDs were run in the sequence of rural, peri-urban, urban 1 and urban 2 across four days to avoid facilitators’ fatigue. Participants provided written informed consent. Member-checking27 was conducted at the end of each FGD by presenting the researchers’ notes to each group for correction and confirmation. The audio recordings were transcribed verbatim by Indonesian researchers (YS, RA, LT). Participants’ identities and other identifying information were removed during the transcription process prior to data analysis. Themes were identified from content analysis of the transcripts in the Indonesian language by Indonesian-speaking re- searchers (BM, YS, RA, LT). A joint coding tree was developed after the four researchers independently coded one transcript and discussed initial codes to reach a consensus. Each of the remaining transcripts was analysed by a minimum of two of the four researchers and then jointly discussed to identify themes. The themes and illustrative quotes were translated to English by BM for discussion with the whole research team until a consensus was reached.
2.3. Consensus-building
Invitations to the consensus-building meeting were sent by a project administrative staff to the Heads of three main pharmacist CPD stake- holders in Kalsel through their respective Secretariat: the Kalsel IAI, the Kalsel Provincial Health Department, and the Faculty of Pharmacy of Lambung Mangkurat University. Participation in the meeting was voluntary. Participants provided written informed consent and received two professional credit points for their contribution. The meeting was structured as a face-to-face modified Nominal Group Technique (NGT)28 which ran for 2 h. First, research team members (BM, YS, RA, and CS through simultaneous translation) presented the preliminary descriptive findings from the survey which were triangulated with FGD data. Par- ticipants were invited to ask clarification questions and share their impression of these preliminary findings. Participants were then asked to answer the NGT question: “What can be done by Kalsel IAI, Kalsel Health Department, and pharmacy educational institution to address the Kalsel pharmacists’ CPD needs in managing NCD?” This NGT question was answered by each participant in turns according to the NGT pro- tocol.28 Participants’ suggestions were listed on a board. In the next step, rather than rank-ordering the suggestions as in the conventional NGT,28 participants were asked to categorise the suggested actions based on their importance and urgency using an Eisenhower Matrix (https ://www.eisenhower.me/eisenhower-matrix/). The two-dimensional nature of the Eisenhower Matrix was deemed more suitable than the one-dimensional ranking of the conventional NGT for the purpose of prioritisation. Items were then scored as follows: Each categorisation as
“urgent and important” was given a score of 3; “not urgent but impor- tant” =2; “urgent but not important” = 1; and “not urgent and not important” =0. The scores were tallied to create a priority action list. In the final step all participants discussed which Kalsel pharmacy groups would be most appropriate to take carriage of the suggested actions.
Data from the consensus building process are reported descriptively.
3. Findings
3.1. Quantitative survey
A response rate of 51% (249/490) was obtained, with 71% of par- ticipants (178/249) completing all questions. The majority of partici- pants were female (129/178, 72%) and the median age was 29 years (interquartile range [IQR] 26, 33 years) (Table 1). Most participants were relatively early in their career with a median of five years’ expe- rience (IQR 2, 9 years) and holding the position of the primary phar- macist in community pharmacies (114/178, 64%). The majority of participants lived within <100 km of the provincial capital (105/177, 59.3%).
The main motivation to attend CPD was networking with colleagues (130/378, 34%) and to gain greater understanding of the CPD topic (116/378, 31%). The main barriers to attending CPD were work com- mitments (118/477, 25%), and the CPD venue being too far (104/477, 22%). No participant expressed disagreement with the idea of using social media for CPD and only 17% (30/178) disagreed that CPD should be compulsory. Almost two-thirds of participants (113/177, 64%) preferred explicitly interactive CPD formats.
Multicollinearity was found between age and work experience, ruling them out for further analysis. Among nine variables included in the logistic regression, the final model only retained one explanatory variable which was years from graduation. For every additional year from graduation, there were 0.94 adjusted lower odds of preferring an explicitly interactive CPD format (p =0.036; 95%CI for adjusted OR 0.89–0.99; Chi-square =4.37; pseudo R2 0.0189; Fig. 1).
B. Marjadi et al.
Research in Social and Administrative Pharmacy xxx (xxxx) xxx
4 Table 1
Descriptive analysis of survey data (n =178).
Characteristics Categories Number of responses % Number of respondents who
answered the question
Gender Female 129 72.5 178
Male 49 27.5
Age, median (lower quartile/LQ, upper quartile/UQ)) 29 (26, 33) 178
Years from graduation, median (LQ, UQ) 5 (2, 9) 178
Work experience in months, median (LQ, UQ) 50.5 (19, 95) 178
Position in pharmacy workplace First pharmacist 114 64.0 157
Second pharmacist 18 10.1
Others 25 25.8
Other roles Academic 21 25.0 84
Distribution 14 16.7
Hospital 17 20.2
Community health centre 13 15.6
Department of Health 8 9.5
Other or unspecified 11 13.1
Working hours per day, mean (SD) 7.2 (3.1) 174
Places of work, total location 0 1 0.6 174
1 125 70.2
2 50 28.1
3 2 1.1
Distance from capital city <100 km 105 59.3 177
100–150 km 27 15.3
>150 km 45 25.4
Monthly average CPD in past year, median (LQ, UQ) 1 (1, 1) 175
CPD documentation preference* Not attend 9 2.6 178
Not document 13 3.7
Note details 21 6.0
Keep certificate 149 42.3
Keep handout 75 21.3
Keep PPT file 51 14.5
Photograph slides 31 8.8
Others 3 0.9
Motivation to attend CPD* Networking with colleagues 130 34.4 178
Don’t know much about the topic 116 30.7
Already know much about the topic 6 1.6
Good local speakers 38 10.1
Good external speakers 67 17.7
Love the food 3 0.8
Others 18 4.8
Barriers of CPD* Fully booked 11 2.3 177
Family commitments 75 15.7
Work commitments 118 24.7
Poor local speakers 2 0.4
Too tired 20 4.2
Not interested in topic 36 7.5
Bad timing 99 20.8
Too far 104 21.8
Poor external speakers 3 0.6
Others 9 1.9
Use of social media for CPD Strongly disagree 0 0.0 178
Disagree 0 0.0
Neutral 7 3.9
Agree 97 54.5
Strongly agree 74 41.6
CPD should be made compulsory Strongly disagree 1 0.6 178
Disagree 29 16.3
Neutral 39 21.9
Agree 84 47.2
Strongly agree 25 14.0
CPD format preference Explicitly interactive† 113 63.8 177
Non-explicitly interactive‡ 64 36.2
* Respondents can choose more than one option.
†Explicitly interactive CPD formats included seminars (defined as ‘a lecture with audience interaction’), a case study with peers, and learning from peers (mentoring, discussion and meeting).
‡Non-explicitly interactive formats included postgraduate education, reading journal articles, a scientific congress, short course (1–2 days), class or lecture, internet materials, webinar, DVD or CD materials, textbook, literature from drug or health device manufacturers, a scientific workshop, peer-reviewing for an academic journal and internship.
B. Marjadi et al.
Research in Social and Administrative Pharmacy xxx (xxxx) xxx
3.2. Focus group discussions
Four FGD sessions were run: one each in rural and peri-urban dis- tricts and two in an urban district. Each FGD was attended by 5–11 participants totalling 29 pharmacists (Table 2). Participants worked in community pharmacies, hospitals, community health centres, and educational institutions. Several participants held multiple positions.
FGD findings are reported below under three themes: Challenges in managing NCD; Strengths and gaps in pharmacists’ NCD knowledge;
and Preferences for NCD CPD. Participants are coded using pseudo- initials and actual work setting (urban/peri-urban/rural).
3.3. Theme 1: Challenges in managing NCD 3.3.1. 1a: NCD risk factors
Participants’ accounts on the increasing number of NCD cases they saw in their practice confirmed the growing problem of NCD in Kalsel, notably cardiovascular disease and diabetes mellitus. One participant reported identifiying 280 cases of hypercholesterolemia among 325 hajj pilgrims [RO/urban]. Dietary factors were the most often cited risk factor since many local traditional foods were high in saturated fat, salt, and sugar. Three examples were reported by participants as often being consumed locally including by NCD patients with cardiovascular dis- eases and/or diabetes mellitus: ketupat Kandangan, a traditional dish of rice cake and fish in thick coconut cream [RO/urban]; sweetened tea and bingka (a traditional sweet snack) [RE/peri-urban]; and salted fish [NA/peri-urban]. Local beliefs such as ‘We haven’t had breakfast until
we eat ketupat Kandangan’ [RO/urban] added to the complexity of NCD prevention and management.
Lack of patients’ knowledge further compounded NCD risk factors.
Lack of NCD knowledge among patients was widely reported, as re- flected by questionable self-diagnosis and self-medication.
“[A patient] came to the pharmacy asking for captopril, although they didn’t know what their blood pressure was. When I asked, they said they got [captopril] from their neighbour, who told them to buy it.” [BR/rural]
Even patients with long-standing NCD may not fully understand how to manage their condition. Another participant reported a case of polypharmacy:
“[During a home visit] I asked ‘May I please look at all the drugs you have here? Be it hypertension or diabetes mellitus drugs, or other drugs you have been taking?’ I was given one full box. I asked ‘Where did you get these drugs?’ Clearly and proudly the patient explained
‘These are from my daughter, one plastic bag; these are from the doctor, one plastic bag; and these are from the community health centre, one plastic bag.’ So I asked him ‘Did you know that these drugs are the same? How do you take these drugs?’ ‘I take them all at once.’ ‘Do you have any complaint when taking all these drugs together?’ ‘Yes, my heart is racing.’ I found in the box: [generic]
spironolactone, Letonal [branded spironolactone], furosemide, and hydrochlorothiazide.” [RA/urban]
3.3.2. 1b: Challenges to pharmacists’ role
Participants acknowledged that not all pharmacists were keen to provide patient education to improve patient knowledge. Some com- munity pharmacies did not prioritise patient education because it was time-consuming and not considered revenue-generating [RE/peri- urban]. Rural participants reported a shortage of pharmacists; but even in better-resourced peri-urban and urban areas, heavy patient load limited their ability to provide patient education [RA/urban; RE/peri- urban]. A participant also lamented the futility of patient education when patients could not afford to purchase medications or had no access to continuity of care [FA/urban].
The contested role of pharmacists was identified as another hin- drance to NCD management. Pharmacists had an integral role in several national NCD prevention and management programmes such as Prolanis (Program Pengelolaan Penyakit Kronis =Chronic Diseases Management Programme), Gema Cermat (Gerakan Masyarakat Cerdas Menggunakan Obat =Community Movement for the Smart Use of Medications), Dag- usibu (Dapatkan, Gunakan, Simpan, dan Buang =Obtain, Use, Store, and Discard [medications]), Nusantara Sehat [= Healthy Indonesia, a na- tional primary health care strengthening programme], and PIS-PK [Program Indonesia Sehat dengan Pendekatan Keluarga = Healthy Indonesia Programme using the Family Approach, a door-to-door survey and health examination]. However, this role of pharmacists was dis- missed or supplanted by other health professionals:
“I think as far as policy makers are concerned, pharmacists are not seen to have significant added value [to the programmes]. I mean, anybody can provide medications, so when a service programme is designed, involving doctors and nurses would suffice to run the programme, and we are left behind. Because [the policy makers]
think anybody can deliver drug services and explain how to use drugs, and this conception remains among policy makers to date.
Pharmaceutical care is actually within our areas of competency, but sometimes other health professionals think that they can also deliver it.” [RA/urban]
Challenges to the pharmacists’ role were also reported from patients.
Many patients still perceived dispensing as the only role of pharmacists, and they were confused or disinterested when pharmacists tried to provide education [RA/urban]. Other patients dismissed education Table 2
Characteristics of FGD participants.
Characteristics FGD1 FGD 2 FGD 3 FGD 4 Total
Setting Rural Peri-
urban Urban-
1 Urban-
2
Number of participants 11 7 5 6 29
Gender:
Female 7 1 2 4 14
Male 4 6 3 2 15
Work setting*:
Community pharmacy 3 4 4 2 13
Hospital pharmacy 8 1 2 0 11
Community Health Centre 1 2 1 5 9
Government
Pharmaceutical Depot 1 0 0 0 1
Academia 1 2 2 1 6
* Respondents can choose more than one option.
Fig. 1. Adjusted prediction of choosing explicitly interactive CPD based on the number of years post-graduation.
B. Marjadi et al.
Research in Social and Administrative Pharmacy xxx (xxxx) xxx
6 effort by pharmacists since “[patients] assume that they have known [everything]. So when we try to provide additional counselling, they see it as boring.” [ER/peri-urban].
Some participants admitted lacking self-confidence in patient ed- ucation due to perceived gaps in their pre-registration education. Ex- amples of such gaps included the pharmacists’ lack of general NCD knowledge [multiple participants], management of co-morbidities [TO/
rural], interpretation of pathology results [LU/urban], and communi- cation skills [ER/urban].
3.3.3. 1c: Practice context
Participants reported different challenges for NCD management be- tween community pharmacies which were mostly separated from the doctor’s surgery, and hospitals or community health centres where doctors and pharmacists were co-located. In the case study discussion of the patient with ACE inhibitor-induced cough, a participant compared the two contexts:
“The context of this scenario is quite difficult in community phar- macies, because patients may think if they have to go back to the doctor that means they have to pay again. Whereas in a community health centre, we could facilitate [the return consultation], we could take the patient back to the doctor.” [RA/urban]
Participants also reported that many NCD patients went to commu- nity pharmacies with prescription copies which often did not contain the prescriber’s contact details, which prevented pharmacists from con- tacting the prescriber if they had concerns. Community pharmacists could only advise patients to return to the doctor, which patients may refuse due to the possible out-of-pocket and non-financial costs such as time. Some community pharmacists also expressed doubt whether their suggestion for treatment review would be taken collegially by doctors.
Hospital and community health centre pharmacists reported a much closer work relationship with their doctors where they could take pa- tients directly back to the doctor and have a three-way discussion to review the treatment.
3.4. Theme 2: Strengths and gaps in pharmacists’ NCD knowledge Discussion of the two case studies revealed a range of participants’ NCD knowledge levels with knowledge gaps across multiple aspects.
Most participants were able to correctly identify the pharmacology of the drugs involved and the pharmaceutical management of the clinical problems. Participants also correctly identified appropriate patient ed- ucation components including advice for physical activities and dietary control for diabetes mellitus.
In the case of ACE Inhibitor-induced cough, most participants correctly identified the pathophysiology and the need to review the anti- hypertensive treatment. However, participants differed in what they would do for management of the cough. Some participants suggested exploring the possible causes of the cough through establishing a timeline in relation to captopril treatment (MA/urban) and excluding other causes such as allergies to pets or house dust (PO/urban). Some correctly stated that the mucolytic was unnecessary because the cough would cease once the ACE-inhibitor was substituted; yet, others sug- gested the use of an antitussive or expectorant to manage the cough.
Participants who suggested the use of an antitussive or expectorant were primarily concerned with symptomatic relief for the patient, including what they believed the patient would want, rather than the underlying pathophysiology of the iatrogenic cough:
“In community health centres, the patients are mainly from middle and low [socio-economic class] and therefore if they have symptoms regardless of the underlying condition they insist on getting what they want. [They] must get some medication. […] For example, for elderly women [like in this case study] their favourite [cough medication] in our community health centre is OBH [an
expectorant]. So if she could get OBH she would be happy, and hopefully that happiness could increase her immune system [all participants laughed] … Or we could just give her vitamin B complex, that would be okay, too.” [AR/urban]
In the diabetes mellitus case discussions, most participants correctly identified key issues with the patient such as poor kidney function as a contraindication for metformin. Although only a few participants identified the significance of an elevated HbA1c level without prompt- ing, discussions around HbA1c and random blood glucose levels demonstrated participants’ understanding of diabetes mellitus man- agement in the case study.
3.5. Theme 3: Preferences for NCD CPD
All participants confirmed the need for NCD-focused CPD for Kalsel pharmacists. They discussed barriers to attending CPD and offered a wide range of suggestions.
3.5.1. 3a. The need for NCD CPD
Several participants expressed their wish to have regular NCD CPD similar to CPD provided to the medical profession in order to increase their knowledge level to be on par with doctors. They believed such CPD would facilitate a more collegial relationship. Several participants pointed out superior CPD systems for doctors which they aspired to have. Some participants reported their avoidance of discussing cases with doctors, such as during inter-professional hospital ward rounds, for fear of displaying a lack of knowledge which they would find embar- rassing [AM/rural; BR/rural; RI/peri-urban]. Three urban participants discussed the importance of keeping on par with doctors:
GU: I think this has more to do with updates … In the past drug A was allowed, not anymore. There is this interaction, that interaction.
LU: The thing is, doctors know this first. So, when we receive a prescription, [we think] ‘Why is this patient given this drug, isn’t it forbidden?’ But what we thought to be forbidden as it turned out was already allowed. Those kinds of updates.
RA: So, we are lagging in information.
GU: If we are lagging, we will end up being laughed at.
3.5.2. 3b: CPD content
Participants agreed on the importance of tailoring CPD content and format to the three main practice domains of Indonesian pharmacists:
clinical pharmacists (in hospitals, community health centres, and com- munity pharmacies); industry pharmacists; and distribution pharma- cists. Certain CPD topics would benefit from deeper discussion with a more focused group; for example, CPD on cytotoxic medications would be mainly relevant for hospital pharmacists because community phar- macies did not commonly distribute them. A few community pharma- cists indicated their need for seminars about business development strategies, which may not be relevant for the community health centres which are a part of the public healthcare system [GU/urban]. Other topics such as hypertension may be delivered as a seminar to all phar- macists, followed by separate group discussions for clinical, industry, and distribution pharmacists to explore setting-specific issues [IK/peri- urban].
3.5.3. 3c: CPD format
Most participants stated that didactic seminars with a large audience, which is the common CPD format provided to them, had limited effec- tiveness. Didactic events prompted participants to “Come, pay, go home” [JU/urban]. Participants unanimously expressed a desire for case discussions in small groups – preferably based on practice set- tings – to apply the theoretical knowledge from seminars to day-to-day practice. Several participants suggested the FGD used for this research B. Marjadi et al.
Research in Social and Administrative Pharmacy xxx (xxxx) xxx project, with its two case studies, as an ideal model for NCD CPD.
A few participants suggested a coaching format where a combina- tion of seminar and case discussion is followed by field practice with regular discussion with and feedback from experts. A few participants, supported by the majority, raised the need for a systematic NCD CPD curriculum and to move away from one-off sessions with seemingly random and unrelated topics. Participants suggested CPD events to focus on a disease for a period of time, where the disease would be discussed from various angles involving multiple health professions, interspersed by practice training to improve clinical skills related to its management.
3.5.4. 3d: Resource persons
Participants believed that the ideal speakers for NCD CPD would be practice experts who could discuss day-to-day practice instead of, or in addition to, academics who were perceived as theoretical experts.
Speakers should understand the practical needs of the audience – such as what to do in patient care – and pitch their presentations accordingly, rather than focusing too much on theories [ER/urban; IK/peri-urban].
External speakers from the most developed island of Java were appre- ciated; however, as these guest speakers may not have the contextual knowledge of local situations, local experts must also be included. One participant suggested having policy makers as speakers so that they could discuss the challenges faced by frontline pharmacists and take them into account in future policy-making [IK/peri-urban].
Many participants suggested an interprofessional learning approach for NCD CPD, noting the complex nature of NCD clinical care.
Participants suggested involving medical, nursing, midwifery, pathol- ogy and allied health professionals as both speakers and participants in NCD CPD, in a combination of uni-professional and multi-professional lectures and discussions [LU/urban; JU/urban; HA/peri-urban].
3.5.5. 3e: NCD CPD barriers
Participants identified time as the biggest barrier for undertaking CPD. Some participants worked six days a week and struggled to find a cover for their clinical duties when attending CPD [LU/urban]. Partic- ipants also lamented the difficulties in obtaining permission to attend CPD. Unlike doctors, many pharmacists could not claim work time for CPD; some managers considered CPD as personal (not professional) development and thus required pharmacists to take personal leave to attend CPD. This time barrier was more prominent for rural pharmacists because most CPD events were held in the provincial capital which required them to add travel time and possible overnight accommodation.
Participants reported that some CPD activities were not recognised in the national professional re-certification guidelines, such as reading journal articles and case discussions with peers via social media, and thus could not be used as evidence to obtain professional credit points.
Some CPD activities were also not recognised for job promotion in the public sector:
“For us in community health centres, for scientific updates we can use [online methods], but for the purpose of acknowledgment for us the format needs to be a training. So for only updating science for knowledge we don’t mind using social media, but for a valid certif- icate we look for training, not seminar. In public institutions, the organising institution [for CPD] must be accredited [to be acknowledged] as scoring points for human resources for health, for competitions, or for job promotion.” [AR/urban]
The time and permission barriers to undertake recognised CPD ac- tivities led some pharmacists to become “professional credit point hunters” using illegitimate means, as reported in all FGDs. Some pharmacists were reported to “consign” CPD certificates by paying for CPD events but not attending it, and then asking a colleague who attended to collect the certificates for them [HA/peri-urban]. This practice was reported to be more prominent among the more geographically- and time-constrained rural pharmacists [JU/urban].
However, participants also acknowledged that once the required pro- fessional credit points for re-certification were obtained, they tended to be more selective in attending CPD based on their view of the topic’s relevance to their daily work [ER/peri-urban].
3.5.6. 3f: Suggestions for improvement
Participants suggested that the focus of CPD recognition should be on evidencing learning, rather than attendance. For example, rather than relying on certificates of attendance, pharmacists should be required to submit written summaries of their learning for re- certification [peri-urban group]. Some participants suggested exami- nations such as the Objective Structured Clinical/Practical Examina- tions (OSCE/OSPE) as the sole pathway to re-certification. However, other participants were quick to point out that OSCE/OSPE were not suitable for industry and distribution pharmacists whose work domain did not include direct patient care. A few urban and peri-urban partic- ipants suggested formal recognition upon completion of a series of CPD, from a micro-credentialing model to status as a specialist phar- macist, akin to specialities for doctors and nurses.
Some suggestions were proposed to overcome the difficulties of rural pharmacists in attending CPD events which were mainly held in the provincial capital. Kalsel IAI could capitalise on the existing social media networks, mainly via WhatsApp and Telegram mobile applica- tions. The national Gema Cermat programme, for example, had an extensive Telegram group with over 3000 members nationally including Indonesian diaspora overseas. Although these networks were used in Kalsel, participation levels varied and was sometimes limited to the same people. Not all pharmacists had the technical skills to make full use of the applications’ functionalities such as for videoconferencing [JU/
urban]. Others were reluctant to join social media discussions, partic- ularly if they had to scroll through a high number of posts at the end of a long working day [TI/rural; RA/urban].
Participants also discussed the possibilities for web-based online learning. Interactive, small group videoconference was suggested by rural participants; however, some rural and peri-urban areas have un- reliable internet access which only supported text discussions and not live streaming. Meanwhile, accessing online literature was not a popular CPD method:
“For pharmacists who, pardon me, those who only think about rev- enue, they will think ‘What is this clinical article for? It is not that important because all I’m looking for is revenue.’ […] Those of us who are academics find journal articles interesting, but not for others.” [JU/urban]
A few rural and urban participants suggested a peer training scheme for rural pharmacists which could be established following a train-the-trainer programme. However, lack of confidence was iden- tified as a demotivating factor by an urban group:
“We as pharmacists … since undergraduate years our tagline is ‘I am afraid of making a mistake’.” [JU/urban].
A few participants suggested inter-professional learning at uni- versity as one method to build self-confidence for future pharmacists.
Table 3
Characteristics of consensus building participants (n =11).
Characteristics Number
Gender:
Female 5
Male 6
Work setting:
Community pharmacy 3
Hospital pharmacy 8
Community Health Centre 1
Government Pharmaceutical Depot 1
Academic staff 1
B. Marjadi et al.
Research in Social and Administrative Pharmacy xxx (xxxx) xxx
8 Another suggestion to improve CPD accessibility for rural pharma- cists was to establish regional CPD centres at district capitals and their hospitals. Invited speakers could deliver face-to-face sessions at these centres, while district hospitals may provide training sessions as part of the proposed peer training, micro-credentialing and specialisation schemes.
Lastly, a few participants suggested the establishment of commu- nities of practice (CoP) to provide peer support as an adjunct to NCD CPD. The CoP idea was based on the existing special interest groups within the Kalsel Pharmacist Association and pharmacists groups such as the Indonesian Young Pharmacists Group (IYPG), a national network of new generation of leaders in pharmacy under IAI National29 and
‘Apoteker (=Pharmacist) Agents of Change’ (AoC) which was an integral part of the national programme GeMa CerMat (Gerakan Masyarakat Cerdas Menggunakan Obat =Community Movement for the Smart Use of Medications).30 The proponents of CoP expressed their hope that the COP would help maintaining the interest in professional development in between and beyond NCD CPD events.
3.6. Consensus building
The consensus building meeting was attended by 11 participants representing all invited stakeholder groups (Kalsel IAI, Kalsel Provincial Health Department, and the Faculty of Pharmacy of Lambung Man- gkurat University). Most of the participants listed hospital pharmacy as their primary work setting (Table 3) but they reported during the dis- cussion to work in additional settings, just as the survey and FGD participants.
Fourteen actions were suggested by participants. The consensus building process identified “Surveying suggestions for CPD content” and
“Develop a CPD curriculum” as the top priority actions (Table 4). The two lowest scoring actions “Develop a series of workshops” and
“Training of trainers to deliver NCD CPD” were removed by participants from the priority list. The IAI was appointed to take carriage of 75% (8/
12) of the prioritised actions.
4. Discussion
Our study findings clearly identify both a need and a desire for a tailored CPD programme to develop the pharmacy workforce for man- agement of NCD in Kalsel, Indonesia. To the best of our knowledge this study is the first Indonesian pharmacist-specific CPD needs assessment that a) employed a mixed-method strategy and b) a co-design approach.
The International Pharmaceutical Federation (FIP) stated in 200231 that pharmacists are required to demonstrate a commitment to CPD. The FIP also states that national pharmaceutical associations in co-operation, where appropriate, with schools and faculties of pharmacy and other education providers have a responsibility to facilitate CPD, and that regulatory bodies for pharmacists should put a system in place that assures the public that pharmacists maintain competency throughout their career. The findings of a 2014 international survey22 suggest that half of the 66 countries represented have implemented or partly implanted the 2002 FIP recommendations. A systematic review of the literature up until 201432 identified that CPD or a process of life-long learning that incorporates individualised planning, learning and reflection results in superior outcomes than continuing education without these elements. However, there is a great deal of variation in how CPD is conducted between countries and individual pharmacist preferences. It is important to consider that although CPD requirements may be global, CPD preferences and even specific learning needs are contextual. Thus, the findings of this study are pertinent to the local practice setting. This approach is supported by other researchers of pharmacist CPD in low- and middle-income countries.33
The need for Indonesian pharmacist CPD for NCD is supported by contemporary research in the area. Pharmacy service in Indonesia has shifted toward patient-oriented pharmacy care10 and mandatory CPD requirements for Indonesian pharmacists have been in place since 2010.5,12,34 Despite these developments, our findings corroborate a previous qualitative study that found Indonesian pharmacists perceive themselves as having inadequate knowledge and skills for the manage- ment of chronic NCD.2 Hermansyah et al.6 confirm our findings that apart from knowledge, confidence, interprofessional collaboration and communication skill are some of the common challenges for Indonesian pharmacists.
Our findings suggest that Kalsel pharmacists had reasonable phar- macological knowledge but would benefit from further education in pathophysiology. However, knowledge improvement was of lower need than skill acquisition. Pharmacists identified the need for CPD that would facilitate efficient and effective patient education for NCD. Such skill would include how to education patients in the context of an environment that facilitates misinformation. Additionally, pharmacists identified health inequity concerns with respect to the management of NCD in Kalsel, as well as the challenges that pharmacists face as a profession in being able to effectively contribute. A potential area for CPD is that of advocacy, both for the patient i.e. health advocacy,35 and the profession itself.36
It was apparent that the preferred type of CPD of activity was explicitly interactive. This finding, coupled with the finding that main reason for participating in CPD is to network with colleagues and how to overcome the challenges of performed pharmaceutical care within the current healthcare system, provides a clear direction for the design of a future CPD curriculum in Kalsel. It is recommended that small group CPD activities are designed that are easily accessible and allow for collaborative inquiry. A community of practice model may be a useful approach to the design of the overall CPD strategy. Specific use of
‘learning circles’37–39 may foster a learning culture and facilitate change.
This approach may be supplemented in a hybrid fashion with online or blended learning large-scale activities, such as a Community of Inquiry model.40 Such model may accommodate both the geographic challenge (th
